Overweight, undernourished, and at risk for major health problems. are public schools helping or hurtingthis growing epidemic?

We don't have crowded subways here, so you probably didn't notice the problem, but, according to the Center for Disease Control, the obesity rate in South Carolina has gone from 13.6 percent in 1990 to 25.8 percent in 2002.

It's not just growing, it's starting earlier.

Three times as many kids are morbidly obese now than 20 years ago. We're seeing adult diseases in young people -- type 2 diabetes, hypertension. But isobesity really a collective problem? Isn't this just people being lazy and gluttonous?

Dr. Ann Kulze, MD, a noted local nutritionist, is unequivocal about the matter.

"We are clearly in the midst in the greatest public health crisis we've faced in modern medical times," Kulze says.

Okay, but what about personal responsibility?

"We can maybe say that for adults," Kulze says. "I'm a big believer in personal accountability. Ultimately you put the food in your mouth, and choose not to move." Then her voice grows a bit louder, more passionate. "But with children, they're innocent. They are bearing the burden of something that we've created for them. It's a whole different ball game."

Or a video game, more likely. Teachers, parents, coaches all agree. Kids just don't move as much as they used to. In the 1960s and '70s, 60 percent of kids walked or biked to school. Now it's 16 percent.

And that's going to be harder to change than the menu. The thing is, school lunch has likely improved since you were in school. Federal guidelines adopted in 2003 specify that the menu has to contain less than 30 percent of calories from fat. So Sloppy Joe is balanced by turkey wrap.

And gym is coming back. Now S.C. elementary school kids only get it twice a week, but in three years they'll go to a half-hour every day.

But if kids are definitely getting fatter, are things changing fast enough to keep up?

Soprano Spaghetti, World Music Wafers

It's 10:45 on a Monday at Buist Academy downtown, and first graders Olive and Emily are having lunch. It's National School Lunch Week, made possible by Otis Spunkmeyer Cookies ("Gotta get some!").

The theme this year is "School Lunch: It's Instrumental," and each menu item has a musical theme. The entrée today is Taco Tater Maracas, a baked potato with chili on top, but the girls opt for a Smucker's pre-packaged crustless PB&J.

Olive had oatmeal for breakfast, but Emily, "didn't have many things before school, just some crackers. But we had a big dinner last night: lima beans, green beans, chicken, rice."

As a whole, the kids at Buist, a competitive academic magnet, are, if not well-off, are well-looked after and well-fed at home.

Things are different for kids up at Stall High School in North Charleston, where the family dinner is a rarity. When school nurse Leah Willis started there three years ago, she was getting 80 kids a day in her office.

"We have a large group of teenagers that work in the evenings," she says. "They'd come in here with stomach problems, and I'd be like, 'When was the last time you ate?' It would've been at lunch the previous day, or it would've been a bag of chips or a soda the night before."

Often students would not have eaten for 16 or 18 hours. Because more than 70 percent of students are on free or reduced lunch, Stall was allowed to start a universal bag breakfast program. It's one of 22 schools in Charleston County to have one and the only high school.

At 7:05 a.m., in first period, all 1,262 students get a heat-bag with a breakfast biscuit or burrito, plus fruit, yogurt, juice, maybe a snack bar. Willis says about 90 percent eat them, with the leftovers going to a "backpack buddy" program that fills needy kids' backpacks with food for the weekends.

Visits to the nurse dropped from 80 a day to 30. Paradoxically, giving a kid a sausage biscuit can fight obesity.

"These kids are malnourished," Willis says. "It's a new phenomenon, this population of obese, malnourished people. Mostly what kids are eating, it's not nutrition-laden food, it's calorie-laden food."

Obviously, Willis is not big on carbonated beverages either.

In 2002, Charleston County Schools signed a five-year contract with the Pepsi Bottling Group, giving them exclusive rights to put their vending machines in all 71 district schools.

A 20-oz. Pepsi has 250 calories. A 20-oz. Mountain Dew has 275 calories. Last year, Willis wanted them gone, so her principal, Dr. David Basile, went to bat for her.

"You mean David versus Goliath?" he says, when asked about it. "That's kind of what we did out here."

He called Pepsi and asked them to change out all the soda machines to juice and water. They told him no. They had a contract. Rather than making a big public stink, Basile pushed quietly,

"Eventually, Pepsi cooperated with us," he says. "They said we would be a pilot school."

Now Stall only sells fruit juice and water in drink machines. Its snack machines serve granola bars and trail mix. The cafeteria serves no "a la carte" competitive foods, more baked chicken than fried, and only baked potato chips. There are no candy sales, no donut sales. The staff is on a health program; Willis says the 50 teachers have collectively lost 450 pounds.

So far there's been a few grumbles but no uprising; no student body president has swept into office on a campaign of Ho-Hos and Jolt cola in every locker.

"The kids hate it, and I love it," Willis says. "If I had my druthers, we'd be organic and vegetarian."

"Pepsi Presents Arithmetic"

From an episode of The Simpsons, offering a glimpse of a future world of corporate/educational synergy:

Teacher: "If you have three Pepsis and drink one, how much more refreshed are you?"

Student: "Pepsi?"

Teacher: "Partial credit!"

First off, to be fair, the average student gets only 2 percent of his or her calories from school vending machines.

But that's not the whole story. The situation with Pepsi and Charleston County Schools is pretty complicated, involving not just the machines, which aren't allowed in the cafeterias (although they are often right outside), but also the "a la carte" or "competitive" foods.

So first let's go back to nutritionist Ann Kulze. She has a book -- Dr. Ann's 10-Step Diet -- a website, and a staff. She's the official nutrition consultant for Ruby Tuesday's. And in 2004 she had three of her children attending Buist Academy when something made her really, really upset.

"I found out that, unbeknownst to me, any day of the week, instead of getting the school lunch, which I had paid for, and which has to stick to dietary guidelines, any day of the week they could get pizza, french fries, and chicken nuggets, and the line for those items was five times as long as those for hot lunch."

(For the record, these foods are available only to sixth graders and up at Buist, and the fries are, now, offered only three days a week.)

Kulze wrote a letter and eventually met with the School Board. They took her seriously and started to look closely at not just cafeteria food but the contract they had signed with the Pepsi Bottling Group three years earlier.

When the School Board first considered an exclusive contract with Pepsi, parents were outraged. The issue got national media attention. But cash talks and carrot juice walks, and the district took that $1 million signing bonus and put it straight toward a deficit.

When the School Board tried to wriggle out of the deal earlier this year, Pepsi offered four choices, none of which would financially hurt the corporation. Faced with losing as much as $1.07 million, the School Board chose an option that was financially sound for the district. The new agreement allows no machines in elementary students' reach, and guarantees that those in junior high and high schools have at least half water and juice.

Stall High still has only juice and water. But, arguably, if a kid at Stall wanted a soda, he could get one from a kid at Birney Middle across the street.

Twix or Turkey Wrap?

Todd Bedenbaugh is either the lord of lunch lady land, or the proprietor of 71 kiddie restaurants across Charleston County, or simply the director of food services for the school district. His cafeterias serve up to 35,000 lunches a day, 31,000 of which are based on the National School Lunch program. Those NSLP meals will set you back $1.65 if you're in elementary school, a dime more if you're in middle or high.

It's the 4,000 other lunches, the competitive foods, that cost high dollar. If the school cafeteria were a sit-down restaurant, the waiters would push these meals. At Buist, the competitive foods ("Smart Mouth" brand) are available to the middle schoolers. A Chick-Fil-A-style sandwich, chips, and a can of lemonade will set you back $3.00.

That extra $1.25 is how Bedenbaugh balances his budget. Yet Stall, which has no competitive foods, isn't hurting him. That's because its vending machines aren't competing either.

"To be honest with you, I'm not trying to slam Pepsi," Bedenbaugh says. "But if the schools didn't offer carbonated beverages and Snickers bars and stuff, I'd be okay. But right now it hurts me because a lot of times that's what kids want to eat."

In the wave of healthy attitudes last spring, Bedenbaugh anticipated the school board dumping Pepsi and went to 100 percent fruit juice and baked chips in the dining hall.

"I lost $800,000 trying to be healthy. We lost revenue because we did that."

But what about Stall? Anyone who's shopped at Earth Fare or bought low-sodium tuna knows that healthy food can cost more. Was it costly to make those changes on an administrative level?

"Not at all," Bedenbaugh says. "We were just trying to be a good partner with them and do the right thing, Hopefully the other schools are going to get the message that Stall's doing okay."

But Stall has only seven drink machines. West Ashley High School, with 50 percent more students, has 39 machines. The new school was designed with them in mind, to increase sales and to keep the kids from congregating around them.

When Basile, the Stall principal, switched out the sodas, his take went from $3,000 to $2,000, money that goes to incentive prizes for the students.

West Ashley makes more than $56,000 a year off the machines, and that's still not as much as Wando. West Ashley Principal Bob Olson credits this in part to the facility being used after hours by adult ed programs. He also points out that, even before the new "half-soda" agreement with Pepsi, the machines were already stocked with mostly juice and water -- that's what sells.

He says he's not opposed to getting rid of soda altogether, but the school counts on that money for instructional materials -- lab frogs, dry-erase markers, etc. West Ashley is near the median in county high schools at 2,000 students. It has more kids below the poverty line than Stall, and more above it.

"I'm not opposed to getting rid of sodas entirely," Olson says. "If we could find a way to replace that revenue."

Of course, money from vending machines is not a philanthropic donation from the Pepsi Bottling Group. It comes from parents, who give it to kids. The schools get 43 percent of it; the kids get 240 empty calories.

Ragtime Ranch Dressing, Modern Milk

There are 43,000 students in Charleston County Schools. Have you noticed they don't have any good lunchboxes at Woolworth's anymore? Maybe it's because 35,000 of those students eat in the school cafeteria.

Of those, 4,000 are middle and high school students who eat competitive foods. These range from fries and fried chicken sandwiches to subs and whole-wheat, low-fat pizza. (Bedenbaugh, the food services director, says the kids aren't supposed to know the pizza's healthy; it would hurt sales.)

Competitive foods have to meet only 5 percent of the recommended daily allowance for nutrients, and they also stigmatize poorer kids. You can't get the pizza with your free lunch (over half of Charleston County kids are on free [47 percent] or reduced [7 percent] lunch, which is 40 cents).

But most of the kids eat from the National School Lunch Program menu. The U.S. Department of Agriculture administers the NSLP and claims that kids who eat it consume twice the servings of fruits and vegetables, and more dairy and grain, than kids who bring from home.

They may have a point. A cursory glance around the Buist cafeteria shows that the spawn of Charleston's intelligentsia pack plenty o' Doritos, Oreos, and Flamin' Hot Cheetos -- which, by the way, are a hotter commodity than Google stock.

Looking around the lunchroom, you'll also notice that things have changed a lot since you likely ate in the cafeteria. For one, there's way more waste. Employees and their accompanying benefits are costly, so dishwashers are out. No more trays. Everything is disposable. At Buist there's no silverware, just a small plastic spork (the chef's salads are replete and look healthy, but how to eat one with such flimsy cutlery is anyone's guess).

And thanks to those new guidelines on fat, if they serve burgers one day, they can make it up with wraps the next.

Speaking of burgers, the U.S. Department of Agriculture has a curious role as chef to 28 million children.

"The USDA exists to further the interests of agriculture," says Kulze. "They do not exist to improve nutritional health. The dairy and meat industries are very powerful, a lot more powerful than the fruit and vegetable growers."

The USDA's argument is that they have to pay farmers for surplus products anyway, so why not give it to kids? It's a win-win, right?

Looking at the district menu for October, there are 20 school days. Beef is offered on at least 10 of them, almost always as the only meat source. Bedenbaugh says the district gets about $700,000 a year in commodity surplus food.

The NSLP was established right after World War II, due to a concern that America's men were too scrawny to fight. In the last 25 years of deficit cutting, it's been a common political football.

The Reagan Administration suggested listing ketchup as a vegetable as a cheap way to meet nutritional requirements. The Contract for America in 1994 tried to crack down on those cheapskate kids who might not be quite poor enough to be eligible for free sloppy joes.

And the improvements are hard fought. When the head of the NSLP, a Clinton administration appointee, tried to make the menu healthier in 1992, the beef people mobilized and somehow got the lunch lady union to fight and eventually prevent the changes from going through.

"Collard greens (Oct. 5) are really, really healthy, and broccoli's good," she said. "Sweet potato sticks, I don't know how much bad fat they might have in them. Fresh fruit is good, should be on there every single day. Vegetable soup is good, and turkey wraps. It'd be nice if the wrap had some whole grains."

As the starch-heavy meal that Olive and Emily were fed at Buist shows, the carbohydrate issue hasn't really arisen yet in school lunch nutrition.

"The week of October 17, they have potatoes Monday, Tuesday, Thursday, and Friday," Kulze says. "Potatoes without the skin ... unfortunately the USDA considers them a vegetable, but anyone who knows nutrition doesn't. There are no guidelines for refined carbs, nothing. I call them the Great White Hazards: white rice, white potatoes, white starch. I couldn't find one example of a whole grain for the entire month."

Beans appear three times in 20 lunches, fish once -- twice if the "Scaled-up Sandwich" is fish. (Musical theme, remember?)

"I don't know why it's so skimpy on beans, because they're cheap and they're incredibly nutritious," Kulze says. "We need more fish, and not breaded fish, which we know from studies basically negates the benefits."

"It's heavy on processed food, sausage. Why can't we have some baked chicken breast instead of this processed chicken stuff? There's no policy right now for trans fats in the federal guidelines, even though they have no place in any child's school lunch."

It's worth noting that Kulze's eighth-grade son still eats cafeteria food. She says he knows how to make good choices -- Buist cafeteria manager Jestine Clark points out that salads are available every day. And, of course, Kulze knows her kids eat well at home.

"I don't want to come across as some sort of nutritional nazi or an idealist," she says. "I am practical. Overall, school lunches are reasonably balanced. They are appropriate in calories, and that's good. And I do think that for many kids, this is a healthier lunch than they would otherwise be getting."

The kids at Buist have Miss Clark looking out for them.

"If I see a child come up and want just a drink, I say, where's your lunch? You got to get at least a piece of fruit to go with that," Clark says.

When she first started at Buist 10 years ago, two kids a day ate breakfast. Now 70 do. Clark credits more choices, and "the best staff in the world: Georgette Coleman, Nettie Dilligard, Karen Rivers, and Daisy Thomas."

"I've worked at James Simons (an all-black Title I elementary school in the upper peninsula), and their eating habits are a little different here. Kids here, if you tell them to pick up a fruit or a vegetable, the majority of them will. But kids are gonna be kids. They like hot dogs, they like pizza."